Can I See a Doctor if Work Comp is Denying My Claim?

Several workers dig a pit at a construction site while supervisors watch from above.

If the insurance company is currently denying your Minnesota workers’ compensation claim, it is still very important for your case that you seek medical care. If you don’t seek medical treatment the insurance company will use that against you and claim that you have completely recovered from your injury and therefore you are not entitled to ongoing benefits. The reality is many injured workers with denied work comp claims do not treat despite ongoing issues because they are worried about paying for medical care or treatment.

If you have private health insurance, then you should run your medical care or treatment through that health insurance. Your private health insurance will then have a subrogation interest in your Minnesota workers’ compensation case. The courts refer to entities that have a financial interest in your case as intervenors. Attorneys have an obligation to put them on notice or to let them know that depending on the success of your work comp claim they may be able to be paid back.

Even if you have private health insurance you may still have co-pays and the private health insurance may not completely cover all of your medical expenses. You should keep track of all your out-of-pocket expenses that you incur as a result of a denied workers’ compensation claim. You should also keep track of all medical mileage you incur as a result of going to doctor and physical therapy appointments. In the event of a successful formal hearing or a negotiated settlement you will get paid back for these expenses.

We also recommend to our clients to avoid paying out-of-pocket expenses as much as possible. If the medical provider or bill collectors are coming after our clients for payment, we will send out Letters of Protection. The medical provider does not have to respect the letter or to stop requesting payment but at least will understand there is a pending lawsuit and back off until the end of the lawsuit. We also recommend our clients talk to the billing department of the medical provider and explain that there is a pending work comp claim and ask for a payment plan in which they pay a very minimal monthly amount.

Since the Affordable Care Act, also known as Obamacare, was signed into law, most of our clients now have private health insurance. Unfortunately, some people are still uninsured. If you qualify for MinnCare or UCare or some type of medical assistance, it is very important to apply for this type of help. We also recommend that clients use the Minnesota health insurance exchange to find private health insurance if they do not receive insurance benefits through their employer.

Sometimes we see claims where the underlying injury is accepted, but the employer and insurer are denying the reasonableness or necessity of the doctor’s recommendation for more treatment, which typically is surgery. Obviously, surgeries are expensive and the insurance company wants to avoid paying for this expense. It may seem counter-intuitive, but it’s better to have the surgery and not wait for approval within the Minnesota workers’ compensation system. While pre-approval for surgery claims get scheduled more quickly within the Office of Administrative Hearings, the agency that oversees workers’ compensation claims, this process still will take months and there is almost no possibility for negotiations.

If you wait for a formal hearing to get approval for surgery, then there is no incentive for the insurance company to enter into a settlement. Either the work comp insurer will be forced to pay for the surgery by the judge or they will not have to pay for any of it. The work comp insurer will then also have to pay for ongoing wage loss benefits, such as temporary total disability (TTD) for the time that you are completely out of work. But, if you have the surgery, the insurer will negotiate with the medical providers, the intervenors, to reduce their bills and then pay for them. You would also get reimbursed for the sick or vacation time that you took as a result of the surgery, through the same TTD benefit.

If the insurance company is denying your Minnesota workers’ compensation claim, it is still important for you to see a doctor. Contact an attorney at Meuser Law Office, P.A. today for a free, no-obligation consultation. Our knowledgeable attorneys handle work comp cases on a daily basis and are very familiar with the most current laws. We will ensure you receive the full benefits you are entitled.